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J Wrist Surg 2024; 13(03): 208-214
DOI: 10.1055/s-0043-1771339
Scientific Article

Symptomatic Heterotopic Bone Formation after 1,2 ICSRA in Scaphoid Nonunions

S. C. Ghijsen   *
1   Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
E. Heeg   *
1   Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
T. Teunis
2   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
V. E. C. den Hollander
1   Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
A. H. Schuurman
1   Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
3   Department of Plastic, Reconstructive, and Hand Surgery, Central Military Hospital (CMH), Utrecht, The Netherlands
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Abstract

Background We observed several cases of heterotopic bone formation after a 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) distal radius vascularized bone graft (VBG) for the treatment of scaphoid nonunion. This adverse event seems underreported. Knowledge about factors associated with the formation of heterotopic bone after VBGs might help reduce this adverse event.

Purpose What factors are associated with resected heterotopic bone formation after 1,2 ICSRA distal radius graft for the treatment of scaphoid nonunion?

Patients and Methods We retrospectively reviewed all patients with a scaphoid nonunion treated with a 1,2 ICSRA distal radius graft between 2008 and 2019 in an urban level 1 trauma center in the Netherlands. We included 42 scaphoid nonunions in 41 people treated with the 1,2 ICSRA graft. We assessed potential correlation with patient, fracture, and treatment demographics.

Results Heterotopic bone developed in 23 VBGs (55% [23/42]), of which 5 (12% [5/42]) were resected. Heterotopic bone was located radially (at the pedicle side) in all participants. Except a longer follow-up time (p = 0.028), we found no variables associated with the development of heterotopic bone formation.

Conclusion The location of the heterotopic bone at the pedicle site in all cases suggests a potential association with the periosteal strip. Surgeons might consider not to oversize the periosteal strip as a potential method to prevent heterotopic ossification after VBG.

Level of Evidence Level II, prognostic study.

Keywords

heterotopic bone formation - scaphoid nonunion - 1, 2 ICSRA distal radius graft - vascularized bone graft

Ethical Review Committee

The medical ethical review committee METC Utrecht approved this study and granted a waiver of informed consent.


* These authors shared co-first authorship.




Publication History

Received: 13 December 2022

Accepted: 28 June 2023

Article published online:
28 July 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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